Drug absorption was studied in morbidly obese patients before and after jejunoileal bypass. The absorption of phenoxymethyl penicillin was considerably increased whilst that of paracetamol was unchanged.
Over 500 medical students have been examined for nasal carriage of Staph. pyogenes at weekly intervals over a period ranging from 3 to 12 months.Nasal carriers were classified as persistent, intermittent and occasional. Of the students, 39% were persistent or intermittent carriers in whom the staphylococcus was believed to colonize the skin of the vestibule of the nose; 42% were occasional carriers in whom the staphylococcus was only a chance inhabitant of the nares.Staph. pyogenes was isolated from the anterior nares of persistent carriers on at least 90% of the occasions on which they were examined, and was of the same phage type on each occasion. From intermittent carriers it was isolated less regularly, but on at least 10% of occasions on which they were examined, and it remained of one phage type. Staph. pyogenes was isolated at less than 10% of swabbings from occasional carriers, and at each the organism was of a different phage type.Eighty-nine per cent of persistent and intermittent carrier strains, and 54% of occasional carrier strains could be typed with phage filtrates. The strains not typable with phage filtrates, and found predominantly among occasional carriers, were considered worthy of separate classification, and it is suggested that typability with phage be used as a criterion of pathogenicity for Staph. pyogenes.We wish to thank Prof. T. J. Mackie for his continued interest and advice; Dr J. P. Duguid for criticism and advice; Dr R. E. O. Williams and Miss Joan Rippon of the Staphylococcal Reference Laboratory, Colindale, who very kindly instructed one of us (J.C.G.) in bacteriophage typing; Dr Donald Cruickshank for taking nasal swabs from patients; Dr Cumming of the Blood Transfusion Department, Royal Infirmary, Edinburgh, for permission to swab blood donors, and the medical students who so willingly co-operated in this work.
The reluctance to carry out diagnostic catherization of the bladder because of the danger of introducing infection has increased reliance on mid-stream and 'clean catch' specimens. It must be accepted that such specimens are contaminated to a greater or lesser degree and the problem resolves itself into distinguishing between mere contamination and bacteruria significant of infection. Several investigators have examined urine quantitatively and found that contamination rarely exceeds 105/ml. so that bacterial counts in excess of this are more likely to be significant (Kass, 1955 and1956;Sanford, Favour, Mao, and Harrison, 1956;Macdonald, Levitin, Mallory, and Kass, 1957;Jackson, Grieble, and Knudsen, 1958;and Monzon, Ory, Dobson, Carter, and Yow, 1958).A disadvantage of conventional quantitative techniques is that they are too time consuming for use in the routine diagnostic laboratory. Thus to be useful in a busy laboratory methods of quantitative culture must be simple, quick, and of a degree of accuracy sufficient to enable 10-fold differences in viable count, particularly over the range 103/ml. to 106/ml., to be detected.The aim of the present paper is to compare a modification of the Miles and Misra method with a standard loop technique which fulfils the above criteria.
METHODSThe Miles and Misra modified technique was carried out
The accurate diagnosis of urinary tract infection. in infancy and childhood based on examination of the urine is made difficult by the number of variables involved. These include the age and sex of the patient, method of collection of the urine, time interval between micturition and urine examination, and technique of examination employed. The method of collection of urine is most important and for two common methodsplastic adhesive bags and midstream specimens-we have suggested diagnostic levels for cell and bacterial counts related to the age and sex of the patient and the type of collection 'Braude et al., 1967).To determine the validity of these levels non-catheter and -atheter specimens of urine were obtained from 68 patients.
MaterialIn most of the patients the suspicion had arisen on clinical grounds that urinary tract infection might be present-a suspicion based on suggestive symptoms such as abdominal pain, dysuria, frequency of micturition, enuresis, unexplained vromiting or anorexia, and, in the case of infants, unexplained failure to thrive. Also in a number of symptomless cases routine examination of the urine had suggested that infection might be present. Of the 68 patients 49 were female and 19 nale. The ages ranged from 9 days to 11 years (see Table).
MethodsWith the methods described by Braude et al. (1967) operator holds the catheter in position an assistant slowly injects 2 ml. of solution. A return flow alongside the catheter should occur. (If it does not the catheter has been inserted too far and the solution is being injected into the bladder. This may modify bacteriological but not cytological results.) The catheter is then withdrawn and the patient left for half an hourIn young boys catheterization often causes discomfort and it is advisable to anaesthetize the posterior urethra before the second or main part of the catheterization procedure by introducing a little anaesthetic jelly (Duncaine) into the urethra immediately after the irrigation procedure.After half an hour has elapsed the operator again scrubs up.and, holding the labia apart or retracting the foreskin, using sterile swabs, the genitalia are resprayed with Polybactrin as described above and the patient is retowelled. The operator puts on sterile gloves and catheterizes the bladder, using a sterile disposable plastic tube size 9 F.G. (feeding or umbilical tube) and a non-touch technique. The assistant, controlling the other end of the catheter with forceps, directs the urine into a sterile container. Normally a few drops are collected into a first bottle, which is discarded, and the remainder of the urine into a second. In small babies there may be little urine in the bladder, and under these circumstances the first bottle has to be used for bacteriological examinations.
Effect of Polybactrin Catheterization on Bacterial Growth in the UrineIn most cases the antibacterial activity of the urine obtained after catheterization was determined by means of indicator plates sown with an antibiotic-sensitive staphylococcus and filter...
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